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Background: Intense and persistent exposure to indoor-air biological agents has been associated with the appearance of allergic diseases. Archives and libraries Indoor environments in tropical countries are an important reservoir of fungal propagules., Objective: To evaluate the degree of air pollution with allergenic fungi in a repository of frequently-manipulated documents., Methods: Air sampling was performed by two methods: active (biocollector) and passive (sedimentation plate). Fungi were taxonomically identified, and spores were measured to determine their penetrability in the human respiratory tract, and its impact on episodes of allergy., Results: In terms of concentration and diversity, the local environment behaved as a fungal propagule reservoir, which showed that there is significant health risk for the staff that manipulates the documents. Some spores were shown to be able to reach the lower respiratory tract when inhaled, which increases their allergenic and pathogenic potential. Aspergillus, Cladosporium, Penicillium and Alternaria, which are referred to as highly allergenic fungi, were prevalent., Conclusion: Aerobiological studies are a valuable tool for the treatment of patients with allergy to fungi and other disorders they produce.

Manuscripts submitted at meetings do not necessarily qualify as scientific papers since they do not adjust themselves to the objectives and structures required. It was concluded through this analysis that a scientific paper is an essential part of the proceeds of scientific research, which is not complete unless their results are published. Such a reason motivated us to conduct this study aimed at updating the methodological structure of the scientific paper, allowing those nursing professionals who review and prepare these texts to develop abilities in this sense, increasing the number and quality of the articles to be published. This bibliographic or documentary review was based on the study on PAHO's documents and from other Cuban authors that devote their time to examine these aspects. The nursing personnel will be able to improve and update their knowledge in this field and on the methodological structure of the scientific paper by this schematic information. This will influence on the quality, scientific and technical level, and national and international projection of the Cuban Journal of Nursing.

This paper addresses the proposition that even though there appears to be unanimity on the biomedical diagnosis of obesity, it is insufficient or not precise enough, since it is necessary to know more about the consequences of different lifestyles in ways of eating and the impact of lifestyles on the health of the population. Therefore, the paper reflects on how the biomedical ideation of obesity contributes to make body weight and food into what from a rather reductionist and controversial approach is defined as a "social problem." Lastly, the standardization of international strategies against obesity is considered, linked to its classification as a global epidemic, in order to reflect on the effects of dealing with a limited view of culture and food. The ideas articulated in this work are part of the theoretical problematization phase of the topic, prior to the implementation of the research project entitled a socio-anthropological approach to childhood obesity in three case studies: Spain, Mexico and Cuba.

Introduction: There has been a significant change in the role of pediatric tracheostomy over the last twenty years. Obstruction of the upper airway caused by infectious agents is no longer the leading cause of tracheostomy in children. Structural anomalies of the upper airway as well as the need for prolonged ventilator assistance have become the most frequent indication for pediatric tracheostomy., Objective: The purpose of this paper is to assess the incidence, indications, complications, and role in mortality of tracheostomy in our pediatric population., Methods: A retrospective descriptive study of pediatric patients who underwent tracheostomy was conducted between 1999 and 2008 in the Pediatric Intensive Care Unit of the José Martí de Sancti Spiritus Pediatric Teaching Hospital in Cuba., Results: Tracheostomy was performed in 14 patients during the period of the study (0.5% of admitted patients). Nine of them (64.2%) were younger than one year. The most frequent indication for the procedure was the need for prolonged mechanical ventilation in patients with neurologic disorders in 10 patients (71.42%). Upper airway malformations and acute infections were infrequent indications for tracheostomy. The most frequent complications were infectious in 10 patients (71.4%) and obstruction in four patients (28.5%). The following germs were found: Pseudomona aeruginosa in six patients (60%), Staphylococcus aureus in three patients (30%), and Enterobacter cloacae in three patients (30%). Furthermore, four patients were successfully decannulated (28.5%), five patients died (35.7%) but only in one (7.14%), death could be attributed to tracheostomy., Conclusion: The need for prolonged mechanical ventilation in patients with neurologic disorders was the main indication for tracheostomy in our pediatric population; most of these children were younger than one year. The procedure had little impact in overall mortality in this group of patients.

Objective: This paper presents the design and application in Cuba of a social construct to identify the social dimensions associated with discrimination attitudes towards people with positive diagnosis to HIV., Materials and Methods: A combination of qualitative and quantitative methodology was used for the measurement and validation of a construct, and also the K-mean procedure and factor analysis techniques. All these techniques were applied to "Survey on HIV prevention indicators" 2005, 2006 and 2009., Results: A tool for the identification of the most frequent discriminatory attitudes in a specific social context was validated. This instrument allows clustering the population into different typologies, by level of discrimination, and also, to distinguish some social dimensions of this phenomenon., Conclusions: The results allow distinguishing frequent discriminatory attitudes in any population, focusing the actions in the direction of gradually reducing them, and to evaluate the temporal behavior of this phenomenon.

Introduction: some physioecological responses from rodents may be registered through the study of morphological indexes, which is an important factor for the control of rodents., Objectives: to compare the morphophysiological variables in two rat populations and relate them to the ectoparasite loads., Methods: this study was carried out from 2007 to 2008 in two sites of La Habana province. Specially prepared traps to catch rats alive were used. Four morphophysiological indexes were studied and then compared through a variance analysis for the two sites., Results: one hundred four Rattus rattus (83.6 %) and Rattus norvegicus (16.4 %) were analyzed. The relative kidney index showed highly significant different between the rat populations. The morphophysiological indexes were lower in parasitized animals. The ecological importance and the implications of these indexes for the control of obtained results were discussed in this paper., Conclusions: the morphophysiological analysis proved that the necessary resources for the survival of these species are available, which favors that both rat sexes bear the ectoparasite load in a better way, and thus they represent parasite reservoirs and a permanent transmission risk.

Cuba reported the first dengue hemorrhagic fever epidemic in the American region in 1981. More than 344 203 cases with 10 312 severe and very severe cases and 158 fatalities were reported. Thirty years after this epidemic, the established surveillance, the control actions and the performed research studies have allowed the country to keep free of dengue, although some epidemics and waves of transmission have occurred, which have finally been eliminated. This paper summarized some interesting aspects related with this epidemic as well as with the laboratory surveillance and results of some of the main research works.

Introduction: Rhodococcus equi is recognized as an emerging pathogen that causes important morbidity and mortality among immunocompromised patients., Objective: to confirm the presence of R. equi in pleural fluid through the restriction fragment length polymorphism technique., Methods: the pleural fluid sample from one AIDS patient with respiratory symptoms was used. Microbiologic culture, staining tests, phenotypic and biochemical tests and restriction fragment length polymorphism technique for the diagnosis of microorganism were performed., Results: the staining technique along with the phenotypic and biochemical tests provided the presumptive diagnosis of R. equi infection, which was further confirmed by the molecular techniques., Conclusions: this paper reported the molecular detection of R. equi from one HIV/aids patient for the first time in Cuba. The results suggested that the molecular biology techniques could be used in the diagnosis and identification of R. equi.

Avian postnatal growth has received considerable attention and its ecological implications have been deeply analyzed. In this current paper, I describe the patterns of culmen and tarsus growth, as well as of weight gain patterns in eight species of herons and egrets (Aves: Ardeidae) found in the Birama Swamp in Eastern Cuba. Between 1998 and 2006,714 nestlings of the following species were measured every two days: Butorides virescens, Bubulcus ibis, Egretta thula, E. tricolor, E. caerulea, E. rufescens, Ardea alba and Nycticorax nycticorax. Logistic and Gompertz equations were adjusted to data using non-lineal regression models with adult values as the asymptote. For each species, the following were determined and recorded: growth rate, age at inflexion, instantaneous growth rates at each age interval, and time taken to reach 90% of adult size. Reported hatchling sizes were similar in other localities, with a variation coefficient ranging between 10-19%. At hatch, each species exhibited differing sizes relative to adult values. In all cases, Gompertz equations were best fitted to explain more variance and lesser residuals. Rates of weight change and tarsus growth were alometrically related to the log of adult weight. Two main growth processes were identified: a physical extension in dimensions of each measurement reflecting inter-specific morphometric differences, and a lineal increase of the growth period from Green Heron to Great Egret. The Black-crowned Night Heron, Cattle Egret and Reddish Egret exhibited some unique measurement characteristics in comparison to the remaining members of the family. All results support the hypothesis that hypermorphosis, as the main evolutionary process in the microevolution of Ardeidae, is caused by a delayed final moment of growth.

Unlabelled: Antiretroviral therapy has marked a change in the course of HIV infection, posing new challenges to improve quality of life in pediatric patients., Objective: The goal of this paper was to identify psychosocial aspects of HIV-infected children and adolescents, and to evaluate their neuropsychological development and psychiatric co-morbidity., Patients and Methods: A descriptive study was conducted, evaluating the neurocognitive performance of patients attending at the Pediatric Department of Instituto de Medicina Tropical Pedro Kourí of La Habana, Cuba, between February and July of 2008. For that purpose, interviews to the patients and their relatives were done with the application of appropriate tests for each age., Results: Twenty-three patients ages 3-17 years (57% female) were studied. Sixteen (69.5%) were infected through vertical transmission, and 7 (30.5%) through other routes. School children infected through vertical transmission showed the most symptoms. Hyperactivity, anxiety, and learning disorders were the most frequently observed symptoms as well as hyperkinetic disorders, temporary tic disorders and mental retardation., Conclusion: This study shows the neuropsychological characterization of HIV-positive children and adolescents, considering the route of acquisition of the infection and the stage of the disease. It also describes psychiatric comorbidity of HIV-infected children.

In the spur-and-groove reefs of the Ecological Reserve Siboney-Juticí (Southeast Cuba) octocorals are one of the predominant components of the sessile fauna. Main objectives of the present paper are characterizing the composition, structure and conservation status of the octocoral communities and assessing on the prevailing environmental conditions in the study area. For data collection, six sampling sites were located every 2-3 km ranging from 12 m to 17 m depth along the spur-and-groove reefs. In each site, 22-26 lm2 quadrants were zigzag arranged every 2 m. The density of colonies was determined per site. The severity degree and predictability of environmental conditions were inferred by using the Heterogeneity and Equitability indexes, respectively. Hydrodynamic stress and the Comparative Pollution Index were also assessed. Current affectations of the octocoral communities were also determined and classified into four main categories: mechanical damage, diseases, predation and invertebrate and macroalgae overgrowth. As a result, 25 species represented by 752 colonies were recorded and Eunicea flexuosa and Gorgonia ventalina were the most abundant. The occurrence of Eunicea succinea forma succinea constituted the first report for Eastern Cuba. Site densities ranged from 3.58 +/- 1.84 to 7.58 +/- 2.16 colonies/m2 and considered from moderate to low. The biggest densities were reported at both sides of the San Juan River mouth. Despite of the composition and structure of the octocoral communities, low to high hydrodynamic stress and low and moderate levels of contamination were inferred, it is likely that these indexes could have been overestimated due to the sensitivity of the indicator species to other factors such as sedimentation. The environmental conditions were mostly favorable and stable. In general, the number of dead colonies was low and mostly caused by the detachment of the substrate and overgrowth of Millepora alcicornis. Injuries were mainly brought about by mechanical damage, followed by coenenchyme loss, predation by Cyphoma gibbosum and macroalgae overgrowth. On the other hand, negative effects by Hermodice carunculata predation, bleaching, Red Band and Black Band Disease were not observed. Among sampled species, G. ventalina colonies were the most severely damaged within the community. As a whole, octocoral communities of spur-and-groove reefs in the Ecological Reserve Siboney-Juticí showed a good conservation status.

Introduction: HIV-1 proviral DNA amplification is the preferential method for HIV diagnosis infection in infants and it has been used in Cuba since 1992. AMPLICOR HIV-1 DNA kit is an in vitro qualitative assay for the detection of HIV-1 proviral DNA in the whole blood., Objective: this paper showed the results of the use of this kit for the first time in Cuba for the perinatal diagnosis of HIV-1 infection., Methods: three hundred forty six whole blood samples from children of HIV seropositive women were analyzed by the AMPLICOR HIV-1 DNA kit in the period 2005-2007., Results: among the tested samples, six were positive, and 340 negative., Conclusions: the assay was reproducible under the Cuban conditions and the achieved results made the diagnosis and follow up of children of HIV-1 seropositive mothers possible.

Introduction: histoplasmosis, an infection caused by Histoplasma capsulatum fungus, is considered as one of the main endemic infections in the American continent where there are frequent epidemic outbreaks. Most of the outbreaks have been associated to risky activities in bat-inhabited places. This paper presented two outbreaks of occupational acquired histoplasmosis occurred in La Habana province., Methods: one hundred and sixteen workers, who performed aerosol-generating tasks in caves, were studied. Samples from the cave soils were taken to assess the existence of the causal agent. Clinical and epidemiological data were gathered for the outbreak characterization., Results: the rates of infection for both outbreaks were 60 % and 78 % respectively. The patients aged 16 to 64 years; additionally, the onset of main clinical manifestations (fever, general malaise, cough, headache, loss of weight, and chest pain) ranged from 10 to 20 days. Histoplasmosis was microbiologically and serologically diagnosed whereas its source of infection was confirmed through H. capsulatum isolation in those places where extensive excavation work had been carried out, resulting in abundant aerosols for up to 21d periods. The similarity between the two outbreaks was the performance of aerosol-generating tasks in risky places without using appropriate safety devices., Conclusions: It is necessary to disseminate the existing preventive measures among the health care staff and the risky groups as well as the general population in order to prevent and take control of possible histoplasmosis outbreaks in the future.

A comprehensive information about the life of Mary Henrietta Kingsley, a British traveller, naturalist and nurse, and the legacy of her beneficent work were provided in this paper. Also, reference was made to medal Mary Kingsley, an award that was created to perpetuate the memory of this outstanding woman and to acknowledge the work of researchers who have attained remarkable results in the field of tropical medicine. A number of details were given regarding the decoration of well-known Cuban scientist Dr Carlos Juan Finlay Barrés with this medal in 1907. This modest article was aimed at saving from oblivion an event of great importance for the history of public health in general and of tropical medicine in particular since the one hundred anniversary of this event is to be celebrated.

A descriptive study was conducted to evaluate the outbreaks of the disease occurred in human beings and animals in the province of Ciego de Avila from 1980 to 2003. It was proved in this paper that the measures taken in animal health and public health have managed to reduce the frequency of outbreaks.

The genomic characterization of the strain used in manufacturing biolarvicide BACTIVET was shown in this paper. Digestion patterns of Bacillus thuringiensis reference strain 266 from the collection of Pushkin Institute located in former Leningrad and of two strains isolated from 2 batches of biolarvicide were compared. Chromosomal DNA digestion was performed by enzymes Hindlll and EcoRI. The same restriction pattern was observed in all cases, which is indicative of genetic stability of the active ingredient of biolarvicide BACTIVET.

Objective: To identify the relationship between emergency visits for acute respiratory illnesses, acute bronchial asthma crisis (ABAC) and acute respiratory infections (ARI), in children less than 14 years of age, and the daily changes of air pollutant levels, in two central hospitals of Havana City, between October 1st 1996 and March 16 1998., Material and Methods: An ecological time series study was conducted. We assessed the relationship between the presence of acute respiratory illnesses, ABAC, and IRA, and exposure to levels of particles less than 10 microg/m3 (PM10), smoke, and sulfur dioxide (SO2); negative binomial regression models were used to assess latency periods of one to five days as well as the cumulative effect of seven days before the emergency visit., Results: The levels of atmospheric pollutants were low, in general. The 24-hour mean values for PM10 levels, smoke, and SO2, were 59.2 microg/m3 (SD=29.2), 27.7 microg/m3 (SD=21.2), and 21.1 microg/m3 (SD=20.1), respectively. An increase of 20 microg/m3 in the daily average of black smoke was associated with a 2.2% increase (95% CI 0.9-3.6) in the number of emergency visits for ABAC. A 20 microg/m3 increase in the daily average of black smoke and SO was associated with an increase in ARI of 2.4% (95% CI 1.2-3.6), and 5% (95% CI 1.3-5.3), respectively, with a 5-day lag. We also observed a cumulative effect for all the contaminants studied., Conclusions: These results suggest that air pollution levels in Havana City affect children's respiratory health; therefore implementation of control measures is necessary, especially those aimed at decreasing motor vehicle exhaust fumes. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

In the present paper, we standardized a microtitration assay for the determination of specific activity of glutathione-S-transferase using a Culex quinquefasciatus strain selected in lab with pyrethroid insecticide lambdacyhalothrin for 6 generations (SP6). The saturation values for reduced glutathione and 1-chlorine 2,4-dinitrobenzene were 15 mM and 40 mM, respectively; we also estimated that 3 minutes was the optimal time in order to differentiate resistant strain SP6 from the susceptible reference strain S-Lab (p>0.05). Additionally, the optimized microtitration method allowed testing 4 Culex strains from Cuba (SANTIAGO DE CUBA, SD4, QUIBU AND SP6), one from Venezuela (MIRANDA), one from Colombia (MEDELLIN) and the other from Brazil (RIO DE JANEIRO) for glutathione-S-transferase activity. MIRANDA showed the highest activity for this detoxifying enzyme. However, the mechanism of detoxyfication in all the strains was very unfrequent, which indicates that its role in resistance to insecticide for all the studied strains is not so important. Glutathione-S-transferase values were compared with non-specific esterase and altered acetylcholinesterase frequencies for each of the studied strains.

Objectives: To look at the individual features of three different methods used to estimate simple parameters--means, totals, and percentages, as well as their standard errors--and of logistic regression models, and to describe how such methods can be used for analyzing data obtained from complex samples., Methods: Data from Cuba's Second National Survey of Risk Factors and Non-Communicable Chronic Ailments [Segunda Encuesta Nacional de Factores de Riesgo y Afecciones Crónicas No Transmisibles], which was conducted in 2001, were studied. A complex, stratified multi-stage cluster sampling design was used. Cuba's 14 provinces and the municipality of Isla de la Juventud served as the strata, while the clusters consisted of sampled geographic areas (SGA), blocks, and sectors. Samples were weighted in inverse proportion to their probability of being selected, and estimates were performed by sex and age group (15-34, 35-54, 55-74, and 75 or more years). Taylor approximations were used to estimate variances. Three statistical methods were compared: conventional analysis, which assumes all data were obtained through simple random sampling; weighted analysis, which only takes into account the weight of the samples when performing estimates; and adjusted analysis, which looks at all aspects of the sampling design (namely, the disparity in the probability of being included in the sample and the effect of clustering on the data)., Results: The point estimates obtained with the three different types of analytic methods were similar. Standard error (SE) estimates for the prevalence of overweight and of arterial hypertension that were obtained by conventional analysis were underestimated by 19.3% and by more than 11.5%, respectively, when such estimates were compared to those obtained with the other two analytic methods. On the other hand, weighted analysis generated SE values that were much smaller than those obtained with the other two types of analyses. The same pattern was noted when odds ratios were calculated using the different methods., Conclusions: Analytic methods that take into account the way the data are structured as well as the study design give a more realistic picture of the problem under study and provide more exact estimates of the study parameters and their SE than conventional analytic methods. Because data from epidemiologic and public health research are often obtained through complex sampling designs, the methods described in this paper and the statistical packages that utilize them should be used more widely.

Aims: In this paper we report on Public Health Resolution 90, which regulates the determination and certification of death in Cuba., Method: Public Health Resolution 90 is of great social importance in our country since it allows the determination and certification of death to be lawfully regulated throughout the whole territory. It is the fruit of over ten years work by a national commission which was set up for that purpose. This resolution includes a series of features that are unprecedented on an international level. By legalising all the aspects linked with the determination and certification of death by means of a ministerial resolution (Ministry of Public Health), and not through a law passed by Parliament, no obstacles are created to prevent it from being reassessed and changed in the future in order to keep up with scientific and technical progress. Unlike most legislation throughout the world, this resolution does not regulate the determination of death, or brain death, linked with organ transplants. In fact, the word transplants does not appear anywhere in the resolution. The clinical and instrumental criteria for determining death were grouped under the heading of the well known true signs of death , but included a true sign based on the irreversible loss of brain functions . Although the irreversible absence of respiratory and circulatory functions, together with the presence of post mortem changes, were included as true signs, the national commission concluded that the death of an individual can only be defined in terms of the irreversible loss of brain functions . The clinical and instrumental criteria for determining death are included in two annexes to the resolution, which must be reviewed from time to time by the National Commission for the Determination of Death, as and when scientific and technical progress makes it necessary to do so. Among the instrumental tests used as a diagnostic aid for the irreversible loss of brain functions and, for perhaps the first time in the world, a battery of tests made up of multimodal evoked potentials and electroretinography has been included., Conclusions: Public Health Resolution 90 offers the legal framework for regulating the determination and certification of death in Cuba.

The behavior of mortality from tuberculosis in Cuba from 1902 to 1997 was described. During the xx century, tuberculosis has been studied in various stages, but no papers reflecting its behavior in a comprehensive way have been published so far. To this end, the notifications of tuberculosis and the populations by sex, age and provinces available since 1902 in the archives of the National Statistics Division of the Ministry of Public Health were taken into consideration. The trend and the percentages of variation of the gross and specific rates were analyzed. A descending trend of mortality from tuberculosis with rates from 230.9 x 10(5), in 1902, to 0.7, in 1997, was observed. It decreased 71.7% between 1902 and 1940, 74% between 1943 and 1959, 85% between 1960 and 1978, and 0.16% between 1985 to 1991. It increased 40% from 1991 to 1994 and it decreased 30% from 1994 to 1997. Pulmonary and extrapulmonary tuberculoses descended in the same way. They were higher among females until 1940, but from 1943 on it was observed a predominance in males. The highest rates were observed in the group aged 45 and over. They have been insignificant among individuals under 15 for the last 30 years. The highest rates were reported in the capital of the country. It was concluded that the mortality rates from tuberculosis have decreased remarkably during the present century and that it should disappear as a health problem in the next 10 years.

Three studies were conducted in Cienfuegos province to prove that intestinal amebiasis in Cuba could be an overestimated health problem. The first two studies showed two components of this overestimation: microscopical overdiagnosis and lack of knowledge about Entamoeba dispar, a non-pathogenic species, in most cases in which microscopical examination was correct. This paper reported the third study that showed the third component: the wrong belief that Entamoeba histolytica is resistant to metronidazole. Thirty-five individuals infected with one or both species of E-histolytica-E. dispar combination were given metronidazole at a dose of 250 mg three times daily for 10 days. Stool samples taken immediately after the treatment were tested by ENZYMEBA to detect one or both species and by a multiplex polymerase chain reaction procedure to determine the existing species. The results of these assays revealed that E. histolytica infection disappeared in all the cases, therefore, we may conclude that in Cienfuegos province and probably in the rest of the country, metronidazol remains an effective drug in the treatment of intestinal amebiasis

A brief historical review of Tropical Medicine in Cuba and of the life and work of Pedro Kourí up to the foundation of the institution that bears his name today was made. The achievements attained by this Institute were also included in this paper. With this study we payed a modest homage to the illustrous Dr. Pedro Kourí on the centenary of his birthday and the students and health workers had the opportunity to know part of this Cuban history.

Introduction: The authors describes the past eight years, since an epidemic started in Cuba which mainly affected the nervous system, particularly the optic nerve and the peripheral nerves. It is thought to have been the biggest epidemic involving the nervous system this century, although there may be over-diagnosis. The cause is controversial but is probably nutritional imbalance with additional toxic elements also in some cases. At the present time the continuous, low, notification of new cases means that it is endemic., Development: In this paper we consider the clinical and electrophysiological aspects characteristic of the disorder, the degree of involvement, evolution, incidence and annual follow-up of cases from 1992 to date and their differential diagnosis. We describe the national programme of healthcare for control of the disease in Cuba, the measures designed to reduce the number of patients, most of the results of clinical and epidemiological studies and the possible causes. We also discuss the most likely physiopathological hypotheses.

The existing difficulties in the treatment of leishmaniasis justify the testing of the effect of new products on parasite forms in the search of a therapeutic alternative for the parasitosis. Given the need of establishing a method to evaluate the activity of natural synthetic products in vitro under the Cuban conditions, this paper was aimed at defining the usefulness of p-nitrophenilphosphate as a chromogenic substance for quantification of parasites in plaques from 96 wells. To standardize this colorimetric method the stages of the parasite growth curve were set. The study of linearity and selection of the sample size, which was optional for these assays, showed that it was possible to obtain maximum linear determination coefficient with 20 mm. Likewise, the variation coefficient was compared with and without the chromogen and the effect of changes in culture medium on the reading of absorbances was analyzed. The set limit of quantification proved the need of using chromogen for the purposes of this paper and the general results allow to recommend this less subjective, simpler and quicker methodology to test products of interest in this field.

Given the development of public health, hygiene and epidemiology in Cuba and their linking with primary care, and particularly, the novel approach to health surveillance in its different implementation alternatives, it is necessary to develop new forms and methods for surveillance evaluation at this level. The paper is aimed at presenting methodological proposal for assessing surveillance in primary health care. We made a literature review of known documents, guides or manuals which have been published in Cuba and in other countries and we interviewed a group of experts in this field. An initial instrument was worked out and tested in three health areas of the capital and afterwards, it was modified accordingly. The process of assessment was divided into 4 aspects: structure, process or functioning, results or usefulness and economic evaluation. To assess functioning of surveillance, we took the analysis of its attributes into account, i.e., simplicity, flexibility, acceptability, sensitivity positive predictive value, representativity, opportunity and also integrality and responsiveness capacity. We described steps to be implemented and elements to be considered. Generally, the evaluation should be carried out in a week. The cost of implementing each evaluating process is estimated at 40 Official Announcement. V Workshop of university libraries of Latin and the Caribbean. Upon finishing the evaluation, a report should be submitted with the comprehensive assessment and recommendations for the evaluated level.

Acute respiratory diseases (ARD) are the most common infections in humans and difficult to prevent. Viruses have been recognized as predominant ethiological agents. In Cuba, ARD constitute a major problem of health and are the first cause of morbidity and important cause of mortality. In this paper, rapid diagnosis was performed to 516 clinical samples which arrived to the Reference Respiratory Viruses Laboratory of the Pedro Kourí Institute of Tropical Medicine (IPK) from different parts of Havana City during 1995, 1996 and 1997. The results obtained have shown 218 positive samples (Influenza A, 89; respiratory syncytial virus 52; Influenza B, 45; Adenovirus, 13; human parainfluenza virus(HPIV)-1, 6; HPIV-2, 3 and HPIV-3, 10). Influenza A was the virus most frequently found in adults, whereas in closed population of teen-agers and adults, Influenza B was frequently found. Furthermore, respiratory syncytial virus was the most important pathogen in children's under 1 year of age.

A dengue epidemic that Cuba reported in 1997 registered more than 500,000 cases of dengue fever produced by viral serotype 1. In 1981, there was an epidemic of dengue hemorrhagic fever produced by serotype 2 of the virus. This time 344,203 clinical cases were reported, 10,312 of which were severe cases of hemorrhagic fever that led to 158 fatalities (101 of them among children). The reintroduction of dengue, and specifically of dengue viral serotype 2 (Jamaica genotype), was quickly detected in January 1997 through an active surveillance system with laboratory confirmation of cases in the municipality of Santiago de Cuba, in the province of the same name. The main epidemiological features of this outbreak are reported in this paper. A total of 3,012 cases were reported and serologically confirmed. These included 205 cases classified as dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), 12 of which were case fatalities (all among adults). Secondary infection with dengue virus was one of the most important risk factors for DHF/DSS. Ninety-eight percent of the DHF/DSS cases and 92% of the fatal cases had contracted a secondary infection. It was the first time dengue hemorrhagic fever was documented as a secondary infection 16 to 20 years after initial infection. Belonging to the white racial group was another important risk factor for DHF/DSS, as had been observed during the 1981 epidemic. During the most recent epidemic it was demonstrated that the so called "fever alert" is not useful for early detection of an epidemic. Measures taken by the country's public health officials prevented spread of the epidemic to other municipalities plagued by Aedes aegypti.

In November, 1996, there was an outbreak of acute respiratory infection in children under 3 in the province of Santiago de Cuba. 7 samples of nasopharyngeal exudates were received to determine the causal agent of the outbreak by indirect immunofluorescence technique (4 positive samples, 57.14%). They were inoculated in MDCK cells culture and those cases that presented positive hemadsorption (6 isolates, 85.71%) were analyzed by indirect immunofluorescence techniques (6 positive samples, 100%) and immunoperoxidase (5 positive samples, 83.3%). All the positive samples were classified as influenza A (subtype H3N2) which confirms what is reported in literature in relation to the circulation of this virus during that year at the national and international level. This paper allowed to know the causal agent of the studied outbreak of acute respiratory infection and to determine the circulation of the influenza A subtype H3N2 in that province.

The production of articles resulting from biomedical, clinical, and public health studies that originated in Argentina, Brazil, Chile, Cuba, Mexico, and Venezuela from 1973 through 1992 was analyzed to discover trends in health research in Latin America. From the database of the Institute for Scientific Information (ISI), 41,238 articles with first authors who resided in those countries were extracted. These articles were analyzed by subject area, type of study, country, number of authors and institutions that participated in the investigation, and citations received by each article. Also analyzed were 95 articles in epidemiology selected from a pool of 570 published by authors from the six countries in 11 public health journals that enjoy international prestige. The results showed that the number of published works increased by 117% between the first and last five-year periods within the study period. Clinical research was distributed the most evenly among the countries, and public health research was the most concentrated (60.7% originated in Brazil). The numbers of biomedical and public health research articles showed relatively more growth than those reporting on clinical research throughout the period. A relative decrease was found in articles by only one author, which suggests a greater frequency of team efforts, and an increase was seen in articles with authors tied to two or more national or foreign institutions, which indicates greater cooperation between institutions and countries. The average number of citations received by each article was 3, which was less than half the number received by the articles in the ISI database (7.78). Regarding the subset of 95 articles in epidemiology, the great majority (96%) dealt with infectious diseases or maternal and child health, while in the international literature 78% of such articles were about chronic diseases. This group of articles gave evidence of more cooperation with international institutions and had a citation index of 4.36 per article. It is concluded that, despite the inherent limitations, this type of study reveals some general trends in the development of research in the six Latin American countries with the greatest scientific production and makes it possible to formulate hypotheses on the factors that influence these trends. Taken with the paper caution, the results of studies like this one can be of great value in defining health science and technology policies.

Congenital toxoplasmosis is produced by intrauterine infection of the fetus with Toxoplasma gondii from a mother infected for the first time during her pregnancy and its clinical manifestations depend on the gestational age at the time of infection. This disease is considered a health problem in developed and underdeveloped countries and its early diagnosis is very important as part of the medical care to pregnant women. In this paper periodic screening of anti T. gondii antibodies was carried out in pregnant women from 8 health areas in two peripheral regions of the city Havana, Cuba during 1990 and 1991, by an indirect ELISA. In the first test performed before 12 weeks of pregnancy of was found that 70.9% of the women tested presented anti T. gondii antibodies. The remaining 1606 pregnant women (29.1%) were considered potentially susceptible, so the test was repeated during the second and third trimesters. Only 16(1%) of the negative patients showed antibody titers in the second or third test, confirming that they acquired the infection for the first time during pregnancy.

The presence of 2 agents such as a Cox A9 strain and another mild cytopathogenic effect-producing strain, both isolated from patients presenting with epidemic neuropathy is reported in this paper. A mild cutopathogenic effect which was propagated in successive dilutions was developed in the dilution 10(-4) by means of the neutralization test of a Coxsackie A9 virus with its homologous hyperimmune serum. A gradient in saccharose was performed in a mild cytopathogenic effect-producing strain and a typical cytopathogenic effect of an Enterovirus developed from one of the fractions passed in tissular cultures in the presence phosphonoacetic acid (PAA). The possible pathogenic role of these viruses are discussed.

This paper reports on 2 hemolytic serious reactions in 2 Arabian patients because of the use of primaquine as presumptive antimalarial treatment given in Cuba to all travellers from countries where malaria is endemic. Taking into account the non-existence of imported malaria cases in travellers from the Arab-world since more then 15 years and the frequency of individuals presenting with glucose-6-phosphate dehydrogenase deficiency it is recommended not to use this therapeutic procedure, and to maintain the rest of surveillance measures to all travellers from such region.

The human intestinal infection by Cyclospora cayetanensis, is reported for the first time in Cuba, Ortega, 1993. This coccidian parasite was being identified since several years in humans presenting with diarrhea, as a blue-green Alga, a similar body to cyanobacteria, or similar to a great coccidia. However, it was identified for the first time a genus of Cyclospora, in 1993, and the taxonomic description of the human species as C. cayetanensis is very recent. This paper reports on a child presenting with an acute diarrheal picture in which no other causative agent was found, and describes the morphological characteristics of this rounded organism which measures between 7.7 and 10 micras of diameter and results positive to Ziehl-Neelsen staining. This is a warning for all physicians and biomedical staff in charge of making the laboratory diagnosis of acute diarrheal diseases.

This paper reports on the necessary conditions for plaque development in mild cutopathogenic effect-producing agents which were isolated from samples of the cerebrospinal fluid of patients presenting with epidemic neuropathy.

The percentiles (3,10,25,50,75,90 and 97) of the subscapular/triceps Index (SS/TR), obtained in a sample of 7286 subjects (3721 males and 3765 females) aged 5 to 20 years, were calculated. Median values of SS/TR are generally higher in females up to the age of 13 years approximately, and show a pattern of peripheral distribution of fat during all the period of study. In males, a pattern of central distribution of fat develops starting from age fourteen and becomes more central as age increases. Values obtained were higher than those reported in the literature at all ages and in both sexes. The results reported in this paper show that SS/TR is useful for assessing changes in the pattern of fat distribution during childhood and adolescence.

A national seroepidemiological survey was carried out to assess the prevalence of anti-Toxoplasma gondii antibodies. 8863 samples taken in filter paper through the ELISA test were analyzed and 29.70% positivity was obtained. No significant differences were found regarding sex. Seropositivity increased with age, up to the 20-29 age group, with a stable behavior in over-29-year age groups. The highest percentage of annual change was registered in the 5-9 age group (1.62%). This parameter reached 0.93% in the women's 25-29 age group.

The goal of this paper is to provide information about pregnancy in adolescents and to influence those people who have to do with the situation of pregnant adolescents and the family and social consequences. The research was carried out at the Dr. Carlos Diez del Ciervo Hospital from 1989 to 1990. It included 1,500 cases and the variables considered were mothers' age, marital status, number of gestations, number of childbirth, residence and initiation of sexual life. The main findings are stated in detail.

For a successful use of larvivorous fishes as bioregulators of mosquito larvae, deep biological knowledge of such fishes is required. This paper intends to be a contribution to the study of the reproduction of the Rivulus cylindraceus, living in brackish waters of canals close to the coasts. Laboratory research showed that females kept reproducing through all the year, especially in December, February and March. As an average, oviposition was 3 (1-21) eggs; fertility increased with the size of the female. The longest uninterrupted oviposition was 12 days.

Surgery is a recent approach in the treatment of arrhythmias. The first successful surgery of this type was the interruption of the accessory pathway in a patient suffering from the Wolff Parkinson White syndrome. In 25 consecutive patients who underwent surgery, 28 accessory AV pathways were identified with classical endocardial and epicardial mapping. Only three patients experienced recurrence of preexcitation without symptoms; one patient had AV block; and another patient died. In all cases we successfully used either an endocardial or an epicardial approach. The purpose of this paper is to report the Cuban experience with this procedure.

This paper describes the case of a 58-year-old woman suffering from nasal mucous membrane involvement from sarcoidosis, and stresses the importance of the otorhinolaryngological manifestations of this disease and the role of the ORL specialist in diagnosing it. We note that sarcoidosis may first appear in the form of this type of symptoms and that in cases of uncertain or unusual etiology, a histopathological study is essential in diagnosing this process. We then review the treatment used by different authors in the literature, which we also applied to our patient.

In Cuba, the infant mortality rate (IMR) dropped by 65% between 1970 and 1986. The 1986 IMR - 13.6% - has put the country in the lead in Latin American mother and child health care. However, the behavior of the IMR is not homogeneous throughout the country. This paper seeks to identify by multiple regression techniques, those sociodemographic or health care factors which have determined the decline in the IMR and those variables which best explain the inter-regional differences in this indicator. Sociodemographic factors fundamentally explain the evolution of the IMR in Cuba; on the other hand, although in the first instance the proportion of live births of low weight and the crude birth rate explain the inter-regional differences in IMR levels every year, it can be seen that other socioeconomic variables really lie behind these differences.

This paper deals with the study of 927 patients of both sexes, with multiprogramable pacemakers implanted during 1987-1988 period, at the "Comandante Manuel Fajardo" Teaching Hospital and the Institute of Cardiology and Cardiovascular Surgery. Complications accounted for 14.9% and the most frequent were, in decreasing order, as follows: sepsis of the pocket (46.7%), hematoma of the pocket, increased threshold and, in a lower percentage, aseptic necrosis (5.7%). Emphasis is made in the role of the nurse in front of a patient with pacemaker and of the different complications presented.

This paper deals with the study by Knott technique, membrane filter and indirect immunofluorescence, of 256 individuals living in Pinar del Rio City, neighbors of a patient suffering elephantiasis produced by Wuchereria bancrofti, 111 donors of the blood bank in the same city, and 10 patients coming from endemic areas who were hospitalized at the "Pedro Kouri" Tropical Medicine Institute, with certainty diagnosis of bancroftiasis. Circulating microfilariae were not found in the neighbors of the positive case, however, a high antifilaria antibody titer (1:512) was observed in the neighbors, suggesting it that in any time this population could have been in contact with this parasite.

This paper studies all cases affected by 5 parotiditis from January to September 1986 (1767 cases) and 1987 (124 cases), as well as all patients with rubella reported in the same period in 1986 (584 cases) and 1987 (5 cases) in the province of Pinar del Río. The rise in the incidence of the two diseases with an annual basis per 100,000 population during 1986 in the different municipalities is emphasized. The overtly downward trend of these two diseases in 1987 after the administration of the triple viral vaccine--93% for mumps and 99.15% for rubella--is discussed. It was found that these two diseases affected more often school children (5-14 years). It was found that these two diseases are not frequent under the first year of life (76.4 and 120.1 cases per 100,000 population respectively). The percentage of vaccine effectiveness was documented--97.4% for parotiditis and 100% for rubella.

This paper shows the incidence of rotavirus and other pathogenic agents in 256 children under three years of age with a diagnosis of acute diarrhea. This study included the months of December 1983 through May 1984. Rotavirus was found in 27.7% of patients, followed by enteropathogenic E. coli (17%). No positive cases were found in the control group. The highest incidence of rotavirus infection coincided with the coldest months where the lowest volumes of rains were reported.

A serologic study is made in two population groups in the Isle of Youth. A total 268 blood samples in blotting paper are subjected to the hemagglutination inhibition technique, using the Eastern equine encephalomyelitis, Western equine encephalomyelitis, Saint Louis encephalitis, and dengue 2 viruses; 16% positivity to flavivirus was found. A second serum sample was taken in people positive by the hemagglutination inhibition technique in order to carry out the techniques of complement fixation and plate reduction neutralization. Nine cases showed complement-fixating antibodies, which is indicative of recent infection and in 29 cases neutralizing antibodies to SLE virus were found.